PROBIOTIC ‘PROMISING’ TO PREVENT AND TREAT ATOPIC DERMATITIS

Aug 12, 2016

by Kate Johnsonpublished November 09, 2014

ATLANTA — A probiotic extract being developed from the human microbiome could offer drug-free topical therapy for patients with atopic dermatitis, and could protect against pathogenic biofilms, new research shows.

In terms of restoring the damaged skin barrier, "it worked very nicely, equivalently to dexamethasone, yet it is not a steroid," said lead researcher Eva Berkes, MD, chief scientific officer for Quorum Innovations in Sarasota, Florida, which is developing the product.

"The extract also showed activity against pathogenic biofilms, and has anti-inflammatory effects," added Bobban Subhadra, PhD, director of research and development for the company.

The findings, presented in two posters here at the American College of Allergy, Asthma & Immunology 2014, are "very promising," said Peter Lio, MD, professor of clinical dermatology and pediatric dermatology at the Northwestern University Feinberg School of Medicine in Chicago, who was not involved in the study. In addition, they could "shed light on other important roles for normal commensal flora," he added.

Staphylococcus aureusbiofilms — both methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) — play an important role in patients with moderate and severe atopic dermatitis, said Dr Lio.

"Therapies that can disrupt these biofilms have tremendous potential to not only decrease infection risk, but to improve other aspects of the disease as well, since the bacterial colonization likely contributes to inflammation and skin barrier disruption," he explained.

Dr Berkes would not reveal the name of the probiotic because the company's patent on the extract is pending, but she said it is a bacterium with official World Health Organization probiotic status.

"We processed it without chemicals — it is a purely physical processing — to increase its activity, so that it does a little more than it did in pure form," she said.

In the studies presented, the topical extract was used on normal skin samples taken from plastic surgery patients.

In the first study, detergent was used to remove the protective skin lipids so that the dried skin samples resemble atopic dermatitis, Dr Berkes explained.

When the topical probiotic extract was applied to the samples, the effect was similar to dexamethasone in that it restored the integrity of the skin barrier, as measured with skin impedance testing, which is the ability of the skin to resist electrical current, she said.

In addition, levels of filaggrin protein — a critical component of the skin barrier — were twice as high in extract-treated skin as in untreated skin.

In the second study, the probiotic extract was tested for three antibiofilm properties: adhesion, inhibition, and detachment.

Antiadhesion properties were doubled in skin treated with the extract, compared with skin treated with the antibiotics vancomycin and meropenem. In addition, the extract was as effective as the antibiotics in inhibiting the attachment of MRSA biofilm (more than 85% at a concentration of 1 mg/mL), and was five times more effective at detaching MRSA biofilm.

The extract also had bioactivity against MSSA, inhibiting 50% to 60% of MSSA biofilm formation on surfaces.

These findings suggest that the extract "could synergistically both treat and prevent MRSA biofilms in chronic skin diseases such as atopic dermatitis," said Dr Subhadra.

Biofilm diseases are common. They are the cause of almost all hospital-acquired infections and are associated with "incredible morbidity and mortality," said Dr Berkes.

However, no antimicrobial drugs have been approved by the US Food and Drug Administration (FDA) to treat biofilm infections.

"All antibiotics approved by the FDA to date have been tested only in the free-floating form, not attached to any surface," she explained. "However, both pathogenic and benign microbes that live on body surfaces preferentially live in biofilm form. They live in communities protected by microbially-produced extracellular polymers that confer tremendous defense against antibiotics."

With current antibiotics being "notoriously bad" at killing pathogenic biofilms, "this is an area of tremendous need," said Dr Berkes. "As practicing physicians, our eyes have been opened to these clinical issues of unmet and even urgent need."

The company is currently conducting a clinical trial to test the extract as a cosmetic skincare product, and another trial is in the works that will look specifically at atopic dermatitis response, she reported.

"While very promising in vitro, there may be other relevant factors that overshadow this property, so guarded optimism is required moving forward," said Dr Lio. "For example, it remains to be seen if this effect will bear out in patients with filaggrin gene mutation, an important subtype of eczema."

Dr Berkes is chief scientific officer, vice president of research and development, and founder of Quorum Innovations. Dr Subhadra and Dr Lio have disclosed no relevant financial relationships.